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Revascularization strategy in patients with multivessel disease and a major vessel chronically occluded; data from

Eugenio Martuscelli1, Fabrizio Clementi, Mark M Gallagher

  • 1Department of Cardiology, University of Rome Tor Vergata, Italy. e.martuscelli@libero.it

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|November 9, 2007
PubMed

Insights

Complete revascularization in multivessel coronary artery disease with total occlusion significantly improves long-term outcomes. Surgical or percutaneous reopening of the occluded vessel enhances patient prognosis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Multivessel coronary artery disease with total occlusion presents complex revascularization challenges.
  • The impact of complete revascularization strategies on long-term outcomes in this specific patient group remains under-investigated.

Purpose of the Study:

  • To evaluate the long-term effects of complete versus incomplete revascularization in patients with multivessel coronary artery disease and a totally occluded major epicardial vessel.
  • To compare surgical (coronary artery bypass grafting) and percutaneous (coronary angioplasty) revascularization strategies in this population.

Main Methods:

  • Analysis of the CABRI study database, which randomized patients to coronary artery bypass grafting or coronary angioplasty.
  • Selection of patients with a major vessel chronically occluded.
  • Median follow-up of 30 months to assess the combined endpoint of death or Q-wave myocardial infarction.

Main Results:

  • Coronary artery bypass grafting showed a significantly lower incidence of death or Q-wave myocardial infarction compared to coronary angioplasty (6.8% vs 17.5%).
  • Multivariate analysis identified completeness of revascularization (HR 0.26) and age (HR 1.07) as independent predictors of combined endpoints.
  • Successful revascularization of the occluded vessel was associated with improved long-term prognosis.

Conclusions:

  • Achieving complete revascularization by reopening or bypassing the occluded vessel is crucial for better long-term prognosis in patients with multivessel coronary artery disease and chronic total occlusion.
  • The findings support the importance of complete revascularization strategies in managing complex coronary artery disease.
Abstract

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